Diabetes-valentovic

Question 1

Rapid acting

Types

Answer 1

Aspart

Glulisine

Lispro

Question 2

Rapid acting

Onset, peak, duration

Answer 2

5-15min

30-90min

<5h

Question 3

Short acting

Types

Answer 3

Regular insulin

Question 4

Short acting

Onset, peak, duration

Answer 4

30-60 min

2-3hr

5-8hr

Question 5

Intermediate acting

Types

Answer 5

NPH insulin (protamine (protein))

Question 6

Intermediate acting

Onset, peak, duration

Answer 6

1-4hr

4-10hr

10-18hr

Question 7

Long acting

Types

Answer 7

Detemir

Glargine

Degludec

Question 8

Long acting

Onset, peak, duration

Answer 8

0.5-4hr

No peak

18-23 hr (degludec is 42hr)

Question 9

Aspart

Answer 9

Absorbed 3x faster from subcutaneous site than regular insulin

Inject just prior to meal

Injected subq, pump and IV

Question 10

Aspart

Compatibility

Answer 10

Only compatible with NPH insulin

Question 11

Lispro

Modification

Answer 11

Inversion of amino acids proline-lysine at positions 28 and 29 of beta chain

Question 12

Lispro

Answer 12

Monomer

Inject sc, pump, IV

15 min before meal or just after

Question 13

Lispro

Compatibility

Answer 13

Compatible only with NPH insulin in the syringe

Question 14

Glulisine

Answer 14

Inject sc, pumps, IV

Compatible only with NPH

Question 15

Short acting insulin

Administration

Answer 15

Sc, pump, IV, IM

Question 16

Isophane insulin suspension (NPH)

What is it?

Answer 16

Crystallized insulin complexed with pro taming and zinc

Question 17

Detemir

Modification

Answer 17

B30 amino acid threonine omitted and a 14 carbon fatty acid is attached to the B29 amino acid

Question 18

Detemir

Effects on insulin

Answer 18

Constant level of insulin similar to a basal insulin level, no peak

Question 19

Glargine

Answer 19

Onset in 1 hr but constant response

Single injection provides flat level of insulin for 24 hr

Question 20

When do you have an inc insulin requirement?

Answer 20

Fever

Hyperthyroidism

Surgery

Trauma

Infection

Question 21

When do you have a decreased insulin requirement?

Answer 21

N/v

Hypothyroidism

Renal impairment

Liver impairment

Question 22

Insulin

ADR

Answer 22

Hypoglycemia MC

(Sx: sweating, dizziness, nervousness, tremor, hunger)

Hyperglycemia, insulin allergy, lipodystrophies

Question 23

Synthetic amylin analog

Pramlintide

Use

Answer 23

Approved for type 1 and 2 diabetics

Injected sc

Question 24

Synthetic amylin analog

Pramlintide

ADR

Answer 24

Hypoglycemia

Don’t mix with insulin in same syringe

DONT USE IN DIABETIC WITH GASTROPARESIS

Question 25

Stimulate insulin release

Answer 25

Sulphonylureas and meglitinides Chlorpropamide, glyburide, repaglinide, nateglinide

Question 26

Dec hepatic glucos

Answer 26

Biguanides Metformin

Question 27

Dec carbohydrate absorption

Answer 27

A-glucosidase inhibitors Acarbose, miglitol

Question 28

Peripheral cell insulin sensitized

Answer 28

Thiazolinediones Pioglitazone

Question 29

Amylin analogs

Answer 29

Amylin analogs Pramlinitide

Question 30

Glucagon-like analog

Answer 30

Glucagon like peptide 1 agonist Exanatide and liraglutide

Question 31

Dipeptidyl peptidase IV (DPP-4) inhibitor

Answer 31

DPP-4 enzyme inhibitor Sitagliptin, saxagliptin

Question 32

Inc glucose excretion

Answer 32

Sodium-glucose co transporter 2 (SGLT2) inhibitor Canagliflozin

Question 33

Sulphonylureas MOA

Answer 33

Binds to cell surface receptor, stimulates insulin release

Question 34

Sulphonylureas Types

Answer 34

1st gen: chlorpropamide and tolbutamide 2nd gen: glimepiride and glyburide

Question 35

Slphonylureas First and 2nd gen oral hypoglycemics Uses

Answer 35

Type II diabetes Central diabetes insipidus (chlorpropamide in patients who cannot tolerate desmopressin)

Question 36

Slphonylureas First and 2nd gen oral hypoglycemics ADR

Answer 36

Hypoglycemia Contraindication: ketoacidosis must use insulin

Question 37

Slphonylureas First and 2nd gen oral hypoglycemics Contraindications

Answer 37

DKA

Question 38

Meglitinides (repaglinide, nateglinide) MOA

Answer 38

Stimulates pancreatic insulin release

Question 39

Meglitinides (repaglinide, nateglinide) Use

Answer 39

Type II diabetics that are ketoacidosis resistant

Question 40

Meglitinides (repaglinide, nateglinide) ADR and contraindications

Answer 40

Hypoglycemia Can't use in DKA, must treat with insulin

Question 41

Biguanides (metformin) MOA

Answer 41

DOES NOT AFFECT INSULIN SECRETION DOES NOT CAUSE HYPOGLYCEMIA

Question 42

Metformin Can cause... Unique

Answer 42

B12 deficiency

Question 43

Thiazolinediones (pioglitazone and rosiglitazone) ADR

Answer 43

Hepatic dysfunction, elevated transminase levels Monitor liver enzymes! Edema BLACK BOX: may worse heart failure Contraindicated in moderate to severe heart failure

Question 44

Glucagon like peptide-1 (GLP-1) Agonists (exenatide, liraglutide and dulaglutide) Use

Answer 44

Inject sc Can be combined with meformin, sulphonylureas or metaglinides

Question 45

Glucagon like peptide-1 (GLP-1) Agonists (exenatide, liraglutide and dulaglutide) BLACK BOX

Answer 45

Thyroid cancer

Question 46

Glucagon like peptide-1 (GLP-1) Agonists (exenatide, liraglutide and dulaglutide) Contraindications

Answer 46

Liraglutide: family history of thyroid cancer

Question 47

Dipeptidyl peptidase 4 (DPP-4) inhibitors (alogliptin, saxagliptin and sitagliptin) Precautions

Answer 47

Reduce dose when used with a cyp3a4 inhibitor | Ketoconazole, atazanvir, erythromycin

Question 48

Sodium-glucose co-transporter (SGLT2) inhibitors (canagliflozin and dapagliflozin) MOA

Answer 48

Enhances urinary glucose excretion (PCT)

Question 49

Sodium-glucose co-transporter (SGLT2) inhibitors (canagliflozin and dapagliflozin) Use

Answer 49

Type II diabetes

Question 50

Sodium-glucose co-transporter (SGLT2) inhibitors (canagliflozin and dapagliflozin) Contraindications

Answer 50

Severe renal dysfunction Warning for inc ketoacidosis